Forget
about Y2K. With the new millennium fast approaching, the biggest
challenge looming on the horizon might actually be the aging baby boom
generation. True to form, this sizable population group will be a
force to contend with as it reaches its senior years and begins to
experience the disorders associated with older age, including
psychiatric illnesses.

Based
on the predicted increase in the incidence of mental health disorders
among aging "boomers," along with the sheer size of this
group, the number of elderly mentally ill is projected to swell from
about four million in 1970 to 15 million in 2030.

In
the September Archives of General Psychiatry, mental health
experts from around the country warn that "(a) national crisis in
geriatric mental health care is emerging. The present research
infrastructure, healthcare financing, pool of mental healthcare
personnel with appropriate geriatric training, and the mental
healthcare delivery systems are extremely inadequate to meet the
challenges posed by the expected increase in the number of elderly
with mental illnesses." They also advise that "(t)hrough
concerted and timely actions, the upcoming crisis could be converted
into an opportunity to improve our understanding as well as management
of mental illnesses in the elderly."

"If
you look at the current infrastructure for meeting the needs of people
over age 65, it is as if mental illness doesn't exist for this
population," said Dilip Jeste, M.D., professor of psychiatry and
neurosciences at the University of California, San Diego (UCSD) School
of Medicine. Jeste is also Director of Geriatric Psychiatry at
UCSD and the Veterans Affairs San Diego Healthcare System.
"In terms of medical services, community services, support
systems or training programs for caregivers and geriatric mental
health specialists, they are practically non-existent. In
another 10 years we will have a near disaster."

Jeste
is the lead author of the national "Consensus Statement on the
Upcoming Crisis in Geriatric Mental Health: Research Agenda for the
Next Two Decades."

The
authors of the paper
recommend that with the projected quadrupling of elderly mentally ill
by 2030, an aggressive 15-
to 25-year research agenda covering prevention, translational
research, intervention research and health services research should be
put in place to develop strategies for serving this population, and a
nationwide training and education program should be conducted in
parallel.

The
statement summarizes the findings and recommendations resulting from a
workshop on geriatric mental health which focused on the post-war
babies born between 1946 and 1964 as a significant population group
that will begin to hit age 65 in the year 2011. Psychiatric
illnesses from alcohol dependence and anxiety disorders to
schizophrenia and severe depression are a harsh reality among older
adults today, and could become a real nightmare with this population
surge.

The
dramatic increase in the number of older people with mental health
needs is not just a factor of the population size, which alone is
significant: people over 65 are expected to grow in number from 20
million in 1970 to 69.4 million by 2030, outnumbering people between
30 and 44.

To
further compound the problem, the percentage of the population with
mental illness is also expected to increase. There is evidence
that this population group has a higher incidence of mental illness
than previous generations, including a higher rate of substance abuse,
which includes illicit substances, alcohol and prescription drugs.
As better treatment for physical and psychiatric disorders increases
longevity for everyone, the prevalence of these disorders in the
older population will continue to be higher.

In
addition, as more people live longer there will be an increase in
late-onset mental illness, sometimes linked to chronic physical
conditions or underlying neurological disorders such as Alzheimer's
disease. According to Jeste, 30 to 50 percent of people who
develop dementia also develop a treatable psychosis or depression,
which can be the cause of problem behaviors that lead to
institutionalization, when caregivers can no longer manage the patient
at home.

Jeste
notes that some older studies have shown low incidence of mental
illness among the elderly, but the studies themselves have been
plagued by the use of poor diagnostic tools and some of the other
challenges of identifying mental health needs in this population.

"Mental
illness still carries a stigma among all age groups, and the elderly
are not predisposed to seek help or even acknowledge that they have a
psychiatric problem," he said. "Older people who live
alone and have little contact with others are not going to be easily
identified as having a mentalhealth
disorder. And, many caregivers and even primary physicians are
simply not trained to diagnose and treat mental illness in the
geriatric population."

Ageism
may also be a factor. Some data show that primary care providers often
fail to diagnose such common illnesses as depression in the elderly,
with three-quarters of physicians stating in one survey that
depression was "understandable" in older persons; and when
they do diagnose, they often fail to treat it adequately.

The
paper's authors note that ethnic and cultural factors can also play a
role in whether an elderly person gets help for a mental disorder.
They suggest that training and education about mental health and the
elderly be broadened to include not only health professionals, but law
enforcement officers, letter carriers, public workers who come in
contact with the elderly, and the community at large so people in need
of help can be identified and assisted, even if they do not seek
medical care.

The
use of drugs to treat mental illness in the elderly also presents
problems, the paper suggests. Drug therapies are for the most
part studied in a younger population, so the affects of these approved
drugs on older adults is not well understood, particularly when the
patient is more likely to be taking multiple medications for other
conditions.

Finally,
the costs associated with caring for mental illness are a factor.
Medicare and Medicaid coverage for visits, drugs and inpatients stays
is limited. The funding models for health care in general pay
little attention to the needs of older adults with mental disorders,
and current discussions about reform are not focusing on this issue as
a problem that must be solved.